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Ramon C, Shay N, Malka A, Daniel E. Phlegmonous gastritis: Review of the pathophysiology. Am J Med Sci 2024; 367:274-277. [PMID: 38281622 DOI: 10.1016/j.amjms.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/13/2023] [Accepted: 01/23/2024] [Indexed: 01/30/2024]
Abstract
Phlegmonous gastritis is a rare infection of the gastric wall. Clinical presentation of phlegmonous gastritis is generally non-specific and includes epigastric pain, nausea, vomiting and fever. The infection results from a transmural infection of the stomach. Several possible routes for phlegmonous gastritis have been proposed: a direct spread from the injured gastric mucosa site, a hematogenous spread to the stomach from a distant focus and lymphatic spread from a contiguous septic focus. The possibility that swallowing Streptococcus-containing secretion is also mentioned. We present a case of phlegmonous gastritis following a pharyngitis and discuss the routes of phlegmonous gastritis, the possible link to pharyngitis and review the diagnosis and treatment of this condition.
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Affiliation(s)
- Cohen Ramon
- Department of Internal Medicine B, Kaplan Medical Center, Rehovot, Israel.
| | - Nemet Shay
- Department of Clinical Immunology Allergy and AIDS, Kaplan Medical Center, Rehovot, Israel
| | - Attali Malka
- Department of Internal Medicine B, Kaplan Medical Center, Rehovot, Israel
| | - Elbirt Daniel
- Department of Clinical Immunology Allergy and AIDS, Kaplan Medical Center, Rehovot, Israel
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Rugge M, Genta RM, Malfertheiner P, Dinis-Ribeiro M, El-Serag H, Graham DY, Kuipers EJ, Leung WK, Park JY, Rokkas T, Schulz C, El-Omar EM. RE.GA.IN.: the Real-world Gastritis Initiative-updating the updates. Gut 2024; 73:407-441. [PMID: 38383142 DOI: 10.1136/gutjnl-2023-331164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/18/2023] [Indexed: 02/23/2024]
Abstract
At the end of the last century, a far-sighted 'working party' held in Sydney, Australia addressed the clinicopathological issues related to gastric inflammatory diseases. A few years later, an international conference held in Houston, Texas, USA critically updated the seminal Sydney classification. In line with these initiatives, Kyoto Global Consensus Report, flanked by the Maastricht-Florence conferences, added new clinical evidence to the gastritis clinicopathological puzzle.The most relevant topics related to the gastric inflammatory diseases have been addressed by the Real-world Gastritis Initiative (RE.GA.IN.), from disease definitions to the clinical diagnosis and prognosis. This paper reports the conclusions of the RE.GA.IN. consensus process, which culminated in Venice in November 2022 after more than 8 months of intense global scientific deliberations. A forum of gastritis scholars from five continents participated in the multidisciplinary RE.GA.IN. consensus. After lively debates on the most controversial aspects of the gastritis spectrum, the RE.GA.IN. Faculty amalgamated complementary knowledge to distil patient-centred, evidence-based statements to assist health professionals in their real-world clinical practice. The sections of this report focus on: the epidemiology of gastritis; Helicobacter pylori as dominant aetiology of environmental gastritis and as the most important determinant of the gastric oncogenetic field; the evolving knowledge on gastric autoimmunity; the clinicopathological relevance of gastric microbiota; the new diagnostic horizons of endoscopy; and the clinical priority of histologically reporting gastritis in terms of staging. The ultimate goal of RE.GA.IN. was and remains the promotion of further improvement in the clinical management of patients with gastritis.
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Affiliation(s)
- Massimo Rugge
- Department of Medicine-DIMED, University of Padova, Padua, Italy
- Azienda Zero, Veneto Tumour Registry, Padua, Italy
| | - Robert M Genta
- Gastrointestinal Pathology, Inform Diagnostics Research Institute, Dallas, Texas, USA
- Pathology, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Malfertheiner
- Medizinische Klinik und Poliklinik II, Ludwig Maximilian Universität Klinikum München, Munich, Germany
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke Universität Magdeburg, Magdeburg, Germany
| | - Mario Dinis-Ribeiro
- Porto Comprehensive Cancer Center & RISE@CI-IPO, University of Porto, Porto, Portugal
- Gastroenterology Department, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - Hashem El-Serag
- Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
- Houston VA Health Services Research & Development Center of Excellence, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - David Y Graham
- Department of Medicine, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Ernst J Kuipers
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Jin Young Park
- International Agency for Research on Cancer, Lyon, France
| | - Theodore Rokkas
- Gastroenterology, Henry Dunant Hospital Center, Athens, Greece
| | | | - Emad M El-Omar
- Microbiome Research Centre, University of New South Wales, Sydney, New South Wales, Australia
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Kim KR, Shim KN, Choe AR, Lee MJ, Park YH, Song EM, Tae CH, Jung SA. A Case of Intramural Gastric Wall Abscess, a Rare Disease Successfully Treated with Endoscopic Incision and Drainage. Gut Liver 2023; 17:949-953. [PMID: 36700301 PMCID: PMC10651380 DOI: 10.5009/gnl220009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/27/2022] [Accepted: 06/10/2022] [Indexed: 01/27/2023] Open
Abstract
Gastric wall abscess is a rare condition characterized by a purulent inflammatory process resulting in the formation of a pocket of pus in the stomach. As the mucosa is usually intact, it requires various tools such as endoscopic ultrasonography or computed tomography for the differential diagnosis to rule out more common subepithelial tumors. Even after the diagnosis, the treatment for gastric wall abscess was previously restricted to surgical resection in combination with antibiotics. Currently, in order to avoid unnecessary surgery, the alternative method of initial treatment with an endoscopic approach is recommended. It also helps to choose appropriate antibiotics with confirmation of the pathogen by drainage. There are few reports that describe the detailed processing of the endoscopic drainage, and there is no consensus on the treatment. The pathogens that cause gastric wall abscess are usually Streptococci, Staphylococci, and Escherichia coli. There is only one case reported to be caused by Candida albicans. This is the first report of Elizabethkingia anopheles as the pathogen of the gastric wall abscess. Here, we report a case of gastric wall abscess in a 75-year-old man, safely treated by endoscopic drainage and antibiotics, confirmed by isolating the contents of the abscess.
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Affiliation(s)
- Kyung Rok Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ki Nam Shim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - A Reum Choe
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Min Jong Lee
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ye Hyun Park
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Eun Mi Song
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Sung Ae Jung
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
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Venegas Gómez VA, Ruiz Manríquez J, Falcon Antonio OE, Zamora Nava LE. Phlegmonous gastritis associated with invasive Pseudomonas aeruginosa infection. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:651-652. [PMID: 36688428 DOI: 10.17235/reed.2023.9471/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We report the case of a 49 years-old female that was hospitalized due to a recent diagnosis of acute lymphoblastic leukemia. As a consequence of induction chemotherapy (CALGB 10403 scheme), she developed severe neutropenia (0.04 10^3/ul). On day 6 of chemotherapy, she complained of epigastric pain, fever, coffee ground emesis, and melena.
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Affiliation(s)
| | - Jesús Ruiz Manríquez
- Gastrointestinal Endoscopy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México
| | | | - Luis Eduardo Zamora Nava
- Gastrointestinal Endoscopy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México
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Miyagishima D, Fujita N, Suzuki H. Phlegmonous duodenitis in an immunocompromised patient. DEN OPEN 2023; 3:e212. [PMID: 36751396 PMCID: PMC9892821 DOI: 10.1002/deo2.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/29/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023]
Abstract
Phlegmonous duodenitis is an extremely rare condition, and only a few cases have been previously reported. Here, we report a case of phlegmonous duodenitis caused by Streptococcus parasanguinis and Escherichia coli in a 78-year-old immunocompromised patient with diabetes mellitus and immunosuppressive drugs. Abdominal computed tomography showed diffuse thickening of the duodenum and gastric antrum, and esophagogastroduodenoscopy revealed some erosions with purulent discharge and reddish and edematous mucosa in the duodenal bulb. A bacteriological culture test detected the two abovementioned bacteria and established the diagnosis of phlegmonous duodenitis. Following the initiation of antibiotic treatment, his condition rapidly improved. Endoscopists should be aware of this rare entity and pay attention to the endoscopic duodenal findings similar to those of phlegmonous gastritis, particularly in immunocompromised patients who develop abdominal symptoms with severe inflammation.
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Affiliation(s)
- Daisuke Miyagishima
- Department of Gastroenterology and HepatologyNumazu City HospitalShizuokaJapan
| | - Naoto Fujita
- Department of Gastroenterology and HepatologyNumazu City HospitalShizuokaJapan
| | - Hiromasa Suzuki
- Department of Gastroenterology and HepatologyNumazu City HospitalShizuokaJapan
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Yang KC, Kuo HY, Kang JW. Phlegmonous gastritis after biloma drainage: A case report and review of the literature. World J Clin Cases 2022; 10:12430-12439. [PMID: 36483820 PMCID: PMC9724512 DOI: 10.12998/wjcc.v10.i33.12430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 09/28/2022] [Accepted: 10/31/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Phlegmonous gastritis (PG) is a rare bacterial infection of the gastric submucosa and is related to septicemia, direct gastric mucosal injury, or the direct influence of infection or inflammation in neighboring organs. Here, we present a patient who had spontaneous biloma caused by choledocholithiasis and then PG resulting from bile leakage after biloma drainage.
CASE SUMMARY A 79-year-old man with a medical history of hypertension had persistent diffuse abdominal pain for 4 d. Physical examination showed stable vital signs, icteric sclera, diffuse abdominal tenderness, and muscle guarding. Laboratory tests showed hyperbilirubinemia and bandemia. Contrast computed tomography (CT) of the abdomen showed a dilated common bile duct and left subphrenic abscess. Left subphrenic abscess drainage revealed bilious fluid, and infected biloma was confirmed. Repeated abdominal CT for persistent epigastralgia after drainage showed gastric wall thickening. Esophagogastroduodenoscopy (EGD) showed an edematous, hyperemic gastric mucosa with poor distensibility. The gastric mucosal culture yielded Enterococcus faecalis. PG was diagnosed based on imaging, EGD findings, and gastric mucosal culture. The patient recovered successfully with antibiotic treatment.
CONCLUSION PG should be considered in patients with intraabdominal infection, especially from infected organs adjacent to the stomach.
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Affiliation(s)
- Kai-Chun Yang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan
| | - Hsin-Yu Kuo
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan
| | - Jui-Wen Kang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan
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